TN 7 (08-12)
DI 23022.820 Medulloblastoma – with metastases
COMPASSIONATE ALLOWANCE INFORMATION
Primitive Neuroectodermal Tumor; PNET; Infratentorial PNET; MDB; MB
Medulloblastoma is a rare type of malignant brain tumor that occurs in the cerebellum and adjacent tissue (which control body movement and coordination). Medulloblastoma with metastases occurs when the cancerous cells have spread to other parts of the brain and central nervous system, and rarely to elsewhere in the body. Medulloblastomas are primarily a type of childhood brain cancer, and rarely occur in adults.
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Diagnostic testing: Imaging tests include MRI, CT, and radionuclide bone scans. A spinal tap may be performed to obtain cerebral spinal fluid to search for cancer cells or tumor markers. Analysis of the tumor after surgical resection confirms the diagnosis of medulloblastoma.
ONSET AND PROGRESSION
Prognosis is poor for medulloblastoma with metastases.
Surgery alone does not cure this type of cancer. Chemotherapy and radiation are often used in combination with surgery.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for evaluation: A pathology report of biopsy findings. If a pathology report is unavailable, a surgical report or all radiological studies (for example, MRI and CT scans) and treatment notes indicating antineoplastic therapy for metastases may be substituted. If available, spinal tap results.
Suggested Listings for Evaluation:
Medulloblastoma with metastases meets 13.13A or 113.13 upon confirmed diagnosis, regardless of the effectiveness of treatment.
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.